Department of Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda.
Infect Agent Cancer. 2013 Jul 10;8(1):27. doi: 10.1186/1750-9378-8-27.
The quadrivalent HPV vaccine is highly effective in primary prevention of anogenital warts (AGWs). However, there is lack of systematic review in the literature of the epidemiology of AGWs in Sub Saharan Africa (SSA).
To review the prevalence, incidence and risk factors for AGWs in SSA prior to the introduction of HPV vaccination programs.
PubMed/MEDLINE, Africa Index Medicus and HINARI websites were searched for peer reviewed English language published medical literature on AGWs from January 1, 1984 to June 30, 2012. Relevant additional references cited in published papers were also evaluated for inclusion. For inclusion, the article had to meet the following criteria (1) original studies with estimated prevalence and/or incidence rates among men and/or women (2) detailed description of the study population (3) clinical or self-reported diagnosis of AGWs (4) HPV genotyping of histologically confirmed AGWs. The final analysis included 40 studies. Data across different studies were synthesized using descriptive statistics for various subgroups of females and males by geographical area. A meta - analysis of relative risk was conducted for studies that had data reported by HIV status.
The prevalence rates of clinical AGWs among sex workers and women with sexually transmitted diseases (STDs) or at high risk of sexually transmitted infection (STIs) range from 3.3% - 10.7% in East, 2.4% - 14.0% in Central and South, and 3.5% - 10.5% in West African regions. Among pregnant women, the prevalence rates range from 0.4% - 3.0% in East, 0.2% - 7.3% in Central and South and 2.9% in West African regions. Among men, the prevalence rates range from 3.5% - 4.5% in East, 4.8% - 6.0% in Central and South and 4.1% to 7.0% in West African regions. In all regions, the prevalence rates were significantly higher among HIV+ than HIV- women with an overall summary relative risk of 1.62 (95% CI: 143-1.82).The incidence rates range from 1.1 - 2.7 per 100 person-years among women and 1.4 per 100 person years among men. Incidence rate was higher among HIV+ (3.0 per 100 person years) and uncircumcised men (1.7 per 100 person-years) than circumcised men (1.3 per 100 person-years).HIV positivity was a risk factor for AGWs among both men and women. Other risk factors in women include presence of abnormal cervical cytology, co-infection with HPV 52, concurrent bacteria vaginoses and genital ulceration. Among men, other risk factors include cigarette smoking and lack of circumcision.
AGWs are common among selected populations particularly HIV infected men and women. However, there is need for population-based studies that will guide policies on effective prevention, treatment and control of AGWs.
四价人乳头瘤病毒（HPV）疫苗在预防肛门生殖器疣（AGW）的原发性感染方面具有高度有效性。然而，在撒哈拉以南非洲（SSA）地区，有关 AGW 流行病学的系统综述文献仍有所欠缺。
在 HPV 疫苗接种项目引入之前，对 SSA 地区 AGW 的流行率、发病率和危险因素进行综述。
通过 PubMed/MEDLINE、Africa Index Medicus 和 HINARI 网站，检索 1984 年 1 月 1 日至 2012 年 6 月 30 日期间发表的关于 AGW 的同行评审英文医学文献。还对已发表论文中引用的其他相关参考文献进行了评估，以纳入分析。纳入标准为：（1）具有男性和/或女性的估计流行率和/或发病率的原始研究；（2）详细描述研究人群；（3）临床或自我报告的 AGW 诊断；（4）对组织学证实的 AGW 进行 HPV 基因分型。最终分析纳入了 40 项研究。通过对不同研究中按地理区域划分的女性和男性的各种亚组进行描述性统计，对不同研究的数据进行综合分析。对于报告了 HIV 状态数据的研究，进行了相对风险的荟萃分析。
性工作者和患有性传播疾病（STD）或有高风险性传播感染（STI）的女性中，临床 AGW 的流行率在东非为 3.3%至 10.7%，中非和南非为 2.4%至 14.0%，西非为 3.5%至 10.5%。在孕妇中，流行率在东非为 0.4%至 3.0%，中非和南非为 0.2%至 7.3%，西非为 2.9%。在男性中，流行率在东非为 3.5%至 4.5%，中非和南非为 4.8%至 6.0%，西非为 4.1%至 7.0%。在所有地区，HIV 阳性的女性比 HIV 阴性的女性的流行率显著更高，总体综合相对风险为 1.62（95%CI：143-1.82）。发病率在女性中为 1.1 至 2.7 例/100 人年，在男性中为 1.4 例/100 人年。HIV 阳性（3.0 例/100 人年）和未行包皮环切的男性（1.7 例/100 人年）的发病率高于行包皮环切的男性（1.3 例/100 人年）。HIV 阳性是男性和女性 AGW 的危险因素。女性的其他危险因素包括宫颈细胞学异常、HPV 52 合并感染、细菌性阴道病和生殖器溃疡。在男性中，其他危险因素包括吸烟和未行包皮环切。
AGW 在特定人群中较为常见，尤其是感染 HIV 的男性和女性。然而，仍需要进行基于人群的研究，以指导针对 AGW 的有效预防、治疗和控制的政策制定。
